Transcript Slide 1
Morphological features of Acute Viral Hepatitis, Chronic Hepatitis & Hepatic Fibrosis GH 19/5/2009 1 Hepatitis Inflammation of Liver Causes: Viral, Alcohol, immune, Drugs & Toxins Types : Acute, Chronic & Fulminant Viral Hepatitis : ◦ Specific – Hepatitis A, B, C, D, E ◦ Systemic - CMV, EBV GH 19/5/2009 3 Carrier state / Asymptomatic phase Acute hepatitis Chronic Hepatitis ◦ Chronic Persistent Hepatitis (CPH) ◦ Chronic Active Hepatitis (CAH) Fulminant hepatitis GH 19/5/2009 4 Grade1 Grade2 Grade3 Grade 4 Zonal – Toxin/Hypoxia Bridging – Viral severe Interface – Immune Apoptotic - Viral 19/5/2009 GH 6 1 = portal Stage1 Stage2 3 = septal bridging Stage3 2 = periportal 4 = bridging with nodular regeneration Stage4 =cirrhosis 4 GH 19/5/2009 8 Swelling , hydropic and ballooning degeneration , apopptosis Periportal necrosis Inflammation – lymphocytes, Macrophages Mild fatty change – HCV Portal inflammation and Cholestasis GH 19/5/2009 9 GH 19/5/2009 10 GH 19/5/2009 11 GH 19/5/2009 12 Persistent (CPH) & Active (CAH) Lymphoid aggregates periportal, piecemeal & bridging necrosis Periportal, bridging fibrosis Ground-glass cells (HBV) Fatty change (HCV) Apoptosis, lymphocytes & macrophage. GH 19/5/2009 13 Areas of necrosis and collapse of liver lobules seen here as illdefined areas that are pale yellow GH 19/5/2009 14 GH 19/5/2009 15 GH 19/5/2009 16 GH 19/5/2009 17 GH 19/5/2009 18 -Hepatic failure with in 2-3 weeks. -Reactivation of chronic or acute hepatitis -Massive necrosis, shrinkage, wrinkled -Little or massive inflammation -More than a week – regenerative activity -Complete recovery – or - cirrhosis. 19/5/2009 19 Grading of Chronic Hepatitis (grade 0-4 ) According to the degree of inflammation and necrosis. Grade Portal or pei-portal Lobular O None or mild none 1 Portal inflammation. Mild Inflammation. But no necrosis 2 Mild periportal inflammation Focal necrosis 3 Moderate periportal inflammation. More necrosis 4 Severe periportal inflammation. Severe Necrosis Staging of Chronic Hepatitis (stage 0-4 ) According to the degree of fibrosis stage Degree of fibrosis 0 None 1 Minimal portal fibrosis 2 Periportal fibrosis 3 Septal fibrosis with distortion of architecture. 4 Definite cirrhosis Irreversible replacement of normal liver by fibrous connective tissue Causes ◦ Chronic inflammation (e.g., chronic hepatitis) ◦ Toxins, usually chronic exposure (e.g., ethanol) Sequelae ◦ Altered blood flow & perfusion liver cells ◦ Stages: portal (1) periportal (2) bridging (3) cirrhosis (4) ◦ Cirrhosis = diffuse change with nodules of regenerating liver cells encircled by fibrous scar Pathogenesis Fibrosis is not only the result of necrosis, collapse and scar formation but also the result of derangements in the synthesis and degradation of matrix by injured mesenchymal cells that synthesize the various components of the matrix which in the liver are the following categories: 1-COLLAGENS TYPE I,III,V,VI,VII COLLAGEN 2-GLYCOPROTEINS LAMININ, FIBRONECTIN, ENTACTIN., UNDULIN , ELASTIN& PROTEOGLYCANS EVALUATION OF HEPATIC FIBROSIS HISTOLOGICALLY: Masson trichrome stain. Siler reticulin stain. Specific antibodies for collagen types. Dsmin and Vimentin for lipocytes. Vimentin for myofibroblasts. BIOCHEMICAL: Determination of various enzymes in matrix synthesis are of very limited usefulness. Serum laminin in benign fibrosis. BRIDGING FIBROSIS: Central-central. Connects central veins with central veins. It is rare and occurring mostly in chronic passive congestion as in this case. BRIDGING FIBROSIS: Porto-portal. This form is common and usually associated with porto-central fibrosis. It follows a portal inflammation that extends to the terminal, centroacinar, portal venules. BRIDGING FIBROSIS: Porto-central. It occurs after centrolobular necrosis and produces new vascular connections between portal fields and central veins which may lead to cirrhosis. It is the most severe form of bridging necrosis and fibrosis and is most of the times associated with porto-portal fibrosis. Bridging Fibrosis